艾滋病合并播散性马尔尼菲青霉菌病的腹部CT表现

目的 观察艾滋病(AIDS)合并播散性马尔尼菲青霉菌病(PSM)的腹部CT表现.方法 回顾性分析35例AIDS合并播散性PSM的腹部CT扫描表现.结果35例AIDS合并播散性PSM腹部CT示腹腔淋巴结肿大27例(77.1%);肝脾肿大18例(51.4%);肝脾实质病变共11例(31.4%),其中肝内多发低密度结节3例(8.6%),脾内多发低密度结节5例(14.3%),肝密度弥漫减低5例(14.3%)及肝脏强化不均匀5例(14.3%);肠壁增厚3例(8.6%);腹水4例(11.4%);胰腺炎1例(2.9%).结论AIDS合并播散性PSM腹部常多脏器受累,腹腔淋巴结肿大、肝脾肿大、肝脾实质病变是其最常见的腹部CT影像表现.     

艾滋病合并腹部感染的影像学表现

目的 初步探讨艾滋病(AIDS)合并腹部感染的影像学特点. 资料与方法 经病理及实验室检查证实的6例AIDS患者分别为AIDS合并腹腔淋巴结核、脾结核、肠结核、腹膜后马尔尼菲青霉菌病、阿米巴肝脓肿、化脓性胆管炎,全部病例均有完整的CT影像资料. 结果 腹腔淋巴结核表现为腹腔内及腹膜后肿大淋巴结影,中心为低密度,边缘环形强化,脾结核患者脾内散在分布小结节状低密度病灶,肠结核表现为肠壁增厚,管腔狭窄.阿米巴肝脓肿患者肝内囊性病变,边缘强化,化脓性胆管炎患者肝内、外胆管扩张,管壁增厚,管腔内积气.马尔尼菲青霉菌患者腹膜后多组肿大淋巴结,局部融合成团块. 结论 影像检查是发现和评价AIDS腹部合并症的有效方法,可为早期诊断及时治疗提供依据,定性诊断有赖于穿刺活检及实验室检查.     

艾滋病合并腹部病变的影像学表现

讨目的探艾滋病（AIDS）合并腹部病变的影像学表现。方法回顾性分析6例AIDS合并腹部病变影像学表现（包括超声、CT和MR扫描）。全部病例均做了超声和胸腹部CT扫描（其中4例做了腹部CT增强扫描），1例做了胸腹部MR增强扫描。结果6例中腹部结核4例，包括腹腔淋巴结结核3例和胰腺结核1例，皆伴有其他部位结核。腹腔淋巴结结核典型CT表现为增大的腹膜后淋巴结中央低密度改变，增强后呈环状强化；胰腺结核的CT表现为胰头低密度灶，增强后病灶周围轻度强化。播散性卡波西肉瘤1例，胸腹部CT及MR扫描表现为沿增粗的支气管血管束和肝内门静脉周围分布的肿瘤病灶。盆腔恶性肿瘤1例，CT显示盆腔内占位病灶，壁不规则增厚，中央大面积低密度液化坏死区。结论AIDS合并腹部病变可表现为机会性感染和相关的恶性肿瘤，影像表现对诊断非常有帮助。组织活检可确定诊断。     

脾脏结核的CT诊断

目的 探讨脾脏结核的CT表现及其诊断价值.方法 回顾性分析经病理所证实或经抗结核治疗取得明显疗效而确诊的10例脾结核的CT表现.结果 (1)粟粒型脾结核4例,CT表现为脾脏弥漫性肿大,伴有多发粟粒状低密度灶,增强扫描病灶无明显强化;(2)结节型脾结核4例,CT表现为脾内单发或多发结节状低密度灶或混杂密度结节灶,病灶常伴有粉末状或斑点状钙化,增强后边缘轻度强化;(3)脓肿型脾结核2例,CT表现为多个干酪性结节灶相互融合,液化坏死形成较大的囊性病变,边缘轻度强化,周围可伴有卫星灶.其中6例肝门、胰周及腹膜后淋巴结肿大,部分有融合,增强呈典型环状强化.结论 各种类型脾结核CT表现具有一定特征性,CT对脾结核的正确诊断具有重要价值.     

艾滋病并发非结核分枝杆菌感染的影像表现(附5例报告)

目的 探讨艾滋病(AIDS)并发非结核分枝杆菌感染的影像表现,提高对该疾病的认识.方法 对本院2009-05-2010-06经临床实验室诊断的5例AIDS并发非结核分枝杆菌感染的影像及临床资料进行回顾性分析.结果 初诊胸片检查3例异常,2例正常.异常表现包括纵隔增宽3例,同时合并肺内局灶性实变2例和胸膜增厚1例.全部患者进行了胸部CT扫描,异常影像包括纵隔淋巴结受累5例、肺内小结节3例、气腔实变2例、胸膜增厚1例.颈部CT扫描1例,显示颈部多发肿大淋巴结和软组织脓肿,增强后淋巴结结节状强化,脓肿边缘花环状强化.2例治疗后复查的影像显示,纵隔淋巴结进一步加大,肺内病变出现播散并较前进展.结论 AIDS并发非结核分枝杆菌感染的影像表现以纵隔淋巴结增大和肺内小结节灶为主,其他异常表现包括气腔实变、胸膜增厚和软组织脓肿等.     

腹腔及腹膜后间隙淋巴结结核的多层螺旋CT强化特征

目的研究腹腔及腹膜后间隙淋巴结结核的多层螺旋CT强化特征,以提高该疾病的影像诊断水平。方法收集本院经临床病理证实的腹部淋巴结结核19例,在多层螺旋CT强化图像上,观察受累淋巴结的大小、形态、密度、强化类型、优势解剖分布以及淋巴结外器官病变的强化特征。结果94.7%淋巴结结核呈典型的环状强化,仅5.3%增大的淋巴结呈均匀强化。腹部淋巴结结核常优势地累及肠系膜(73.7%)、门腔间隙(63.2%)、肝十二指肠韧带(57.9%)、肝胃韧带(47.4%)和腹主动脉周围上部淋巴结(47.4%)。9例(47.4%)脾增大,其中5例(26.3%)脾内有多发低密度灶,病灶周边强化;6例(31.5%)腹腔积液;3例(15.8%)大网膜、肠系膜和壁层腹膜广泛结节样增厚。结论结核累及腹腔及腹膜后间隙淋巴结的多层螺旋CT强化具有一定特征。     

淋巴瘤累及腹膜、网膜和肠系膜的CT表现

目的 分析淋巴瘤累及腹膜和/或网膜及肠系膜的CT表现.方法 回顾分析11例经临床确诊且均行腹部CT检查的非霍奇金淋巴瘤患者的CT图像.CT征象包括:腹膜线样或结节样增厚、腹水、网膜肿块、淋巴结肿大、实质性脏器累及、肠道病变等.结果 淋巴瘤累及腹膜、网膜和肠系膜均为非霍奇金淋巴瘤(NHL),以弥漫大B细胞型(n=8)多见.CT表现为腹膜线样或结节样增厚10例;网膜结节或肿块6例;系膜结节、肿块或条形密度影10例;腹水9例;肠道病变5例;腹膜后淋巴结肿大9例;肝肿大2例,脾肿大2例,肝、脾同时肿大2例,肾脏浸润1例.结论 淋巴瘤累及腹膜、网膜和肠系膜CT表现缺乏特征性,遇有腹膜和/或系膜和网膜病变时应想到本病的可能.     

脾结核的CT诊断

目的：研究脾结核的CT诊断。方法：回顾性分析经手术病理证实或经抗结核治疗治愈而确诊的15例脾结核的CT表现。结果：15例中14例脾脏增大,11例平扫表现为多发大小不等的结节状或斑点状低密度灶,边界清或欠清,增强后病灶内部不强化,边缘变清楚;1例除脾内多发状低密度灶外,还可见多发小结节状钙化灶;2例为散在小点状钙化灶。10例伴有其他脏器结核,9例伴后腹膜,肝脾门区等淋巴结肿大或钙化,7例淋巴结呈环状强化。结论：脾脏多发大小不等的结节状或斑点状,低密度,无强化病灶是脾结核的主要征象,CT为发现脾结核较好的检查方法。     

肝结核的螺旋CT动态增强扫描表现及诊断价值

目的 探讨各型肝结核的螺旋CT动态增强扫描表现及其诊断价值. 资料与方法 18例肝结核患者行螺旋CT平扫和动态增强扫描,均经手术病理或穿刺活检证实.结果 (1)浆膜型1例:肝包膜呈梭形增厚低密度影,增强扫描病灶内有分隔样强化,邻近肝实质动脉期明显强化.(2)粟粒型8例(病灶最大径<2.0 cm):表现为肝内散在多发(6例)或单发(2例)粟粒小结节状低密度灶,增强扫描动脉期和静脉期病灶边缘轻度强化.(3)结核瘤型7例(病灶最大径≥2.0 cm):表现为单发或多发较大结节或肿块,4例病灶内有斑点状钙化,1例结核性肝脓肿有环形钙化,增强扫描动脉期病灶边缘轻度强化,周围肝组织明显强化,静脉期病灶边缘明显环形强化或病灶内蜂窝状强化.(4)胆管炎型1例:表现为肝门部肝内胆管扩张,增强扫描胆管壁强化,合并有腹膜后和肠系膜根部肿大淋巴结环形强化.(5)混合型1例:表现为肝包膜及邻近肝组织内低密度灶,同时具有浆膜型和结核瘤型的CT表现.结论 将肝结核分为浆膜型、粟粒型、结核瘤型、胆管炎型和混合型5种类型较合理.螺旋CT动态增强扫描能显示肝结核的一些特征性表现,如病灶"边缘强化征"、"蜂窝征"等,有助于该病的定性诊断.     

全身播散性隐球菌病的CT表现

目的: 探讨全身播散性隐球菌病的CT表现.材料和方法: 回顾性分析1例经临床证实的全身播散性隐球菌病患者的胸部、腹部及头颅CT表现.结果: 胸部CT表现为双肺野网状阴影及弥漫性粟粒状微结节影;腹部CT表现为肝脾肿大、腹膜后淋巴结肿大及腹膜后肿块;头颅CT表现为片状低密度灶(隐球菌性脑炎),结节灶(隐球菌性肉芽肿)及脑膜增厚、弥漫性脑膜增强及进行性脑积水(隐球菌性脑膜炎).结论: 隐球菌病CT表现复杂,形式多样,缺乏特异性,误诊率高.     

胰腺结核的CT表现

目的 探讨胰腺结核的CT表现及其诊断价值。方法 8例胰腺结核中,6例经手术病理证实,2例经穿刺活检证实,CT常规平扫加增强扫描。结果 多发结节型 胰腺结核1例,表现为肿大的胰腺内布满结节状低密度灶,仅结节灶边缘轻度强化。局灶 腺结核7例,均累及胰头部。局部软组织肿块4例,其中2例伴有多发斑点状钙化灶,1例呈蜂窝状强化;囊性肿块2例,其中1例囊壁有多发斑点状钙化灶,另1例为多房囊性病灶。胰头部团块状钙化灶1例。8例胰腺结核中4例有腹内胰外表现,包括腹内淋巴结结核、结核性腹膜炎,以及肝、脾结核。结论 胰腺结核CT表现呈多样化,但有一定特征性,伴有多发斑点状钙化灶或呈蜂窝状强化的胰腺肿块,可提示胰腺结核的诊断;与胰腺结核共存的腹内结核特别是特征性淋巴结结核有助于该病的诊断。     

艾滋病肺门纵隔淋巴结结核的影像学表现

目的探讨获得性免疫缺陷综合征(AIDS)合并肺门和纵隔淋巴结结核的影像学表现。方法回顾性分析9例AIDS合并肺门和纵隔淋巴结结核的影像学表现(包括胸部平片、CT和MR扫描)。全部病例均作了胸部平片、CT扫描，5例作了增强CT扫描，1例作了MR检查。结果AIDS合并肺门和纵隔淋巴结结核时，增大的淋巴结主要位于7区9／9例，4R区7／9例，2R区5／9例。结论AIDS合并肺门和纵隔淋巴结结核的影像学表现为多组淋巴结增大，可相互融合及出现淋巴结外侵犯表现，CT和MR扫描对本病的诊断有重要意义。     

免疫损害患者肺结核的影像诊断

目的　探讨几种免疫损害疾病并发肺结核患者的X线和CT所见 ,包括糖尿病、肾移植术后及获得性免疫缺陷综合征 (AIDS)。方法　回顾分析合并有肺结核的 2 0例糖尿病患者的胸部CT所见、10例肾移植术后患者的胸部X线片及 2例AIDS患者的CT片。结果　糖尿病并发肺结核的CT表现为 :大片融合性肺实变 (10例 ) ,在单一病变区内有多发小空洞 (9例 ) ,病变不按肺段分布(2例 ) ,多数病变具有卫星灶。肾移植术后并发肺结核的胸部X线表现为 :斑片及大片融合实变(6例 )和粟粒型肺结核 (4例 )。AIDS病合并肺结核的CT表现为 :纵隔淋巴结肿大 (1例 ) ,肺内浸润(1例 )及胸部以外的结核病变 (2例 ) ,包括颈部及腹膜后淋巴结肿大。结论　 3种免疫损害病变患者并发肺结核的主要CT及X线表现为大片融合病变、单一病变内的多发小空洞、粟粒型肺结核、纵隔淋巴结肿大及胸部以外的淋巴结肿大     

Intraabdominal Mycobacterium tuberculosis vs Mycobacterium avium-intracellulare infections in patients with AIDS: distinction based on CT findings

Abdominal CT scans of 71 patients with AIDS who had proved disseminated infection due to Mycobacterium tuberculosis (27 patients) or Mycobacterium avium-intracellulare (44 patients) were reviewed retrospectively to identify radiologic features that can be used to distinguish the two infections. CT findings in patients with disseminated M. tuberculosis included focal lesions in the liver (11%), spleen (30%), kidneys (19%), pancreas (7%), and gastrointestinal tract (15%) and lymph nodes with central or diffuse low attenuation (93%). CT findings in patients with disseminated M. avium-intracellulare included marked hepatomegaly (20%); marked splenomegaly (14%); focal lesions in the liver (9%), spleen (7%), and kidneys (2%); diffuse jejunal wall thickening (18%); lymph nodes with central low attenuation (14%); and enlarged lymph nodes exclusively of homogeneous soft-tissue density (55%). The presence of focal visceral lesions and low-attenuation lymph nodes suggests disseminated M. tuberculosis, whereas marked hepatic and splenic enlargement, diffuse jejunal wall thickening, and enlarged soft-tissue-density lymph nodes suggest disseminated M. avium-intracellulare. Recognition of these CT features can lead to a tentative diagnosis so that appropriate therapy can be instituted before the results of mycobacterial cultures become available.     

获得性免疫缺陷综合征相关消化道病变的影像学表现

目的：初步探讨艾滋病（AIDs）相关消化道病变的影像学表现。方法：回顾性分析11例AIDS相关消化道病变的影像学表现。行胸部平片检查11例,胸部CT扫描4例,腹部CT扫描9例,盆腔CT扫描2例,盆腔MRI检查1例,消化道内窥镜检查9例。结果：11例中消化道穿孔3例（食管穿孔2例,胃穿孔1例）、肠结核2例、巨细胞性肠炎1例、淋巴瘤4例、胃腺癌1例。食管穿孔的主要影像表现为食管一纵隔瘘伴纵隔淋巴结结核及双肺结核;胃穿孔主要表现为胃瘘伴肝左叶及肝胃间隙脓肿;肠结核主要表现为回盲部肠壁增厚;巨细胞性肠炎主要表现为乙状结肠末段及直肠管壁向心性增厚;淋巴瘤主要表现为受累消化道管壁肿块状增厚,肠腔狭窄或扩张,多伴溃疡及病变周围淋巴结增大;胃腺癌主要表现为胃壁增厚、僵硬及明显强化。结论：AIDS相关消化道病变可表现为多种机会性感染和恶性肿瘤,影像学检查对这些病变的诊断具有重要作用。     

腹部空腔脏器破裂穿孔的螺旋CT诊断价值

目的：探讨螺旋CT在腹部空腔脏器穿孔中的诊断价值。方法：回顾性分析经手术证实的15例腹部空腔脏器穿孔病例的CT表现。结果：胃十二指肠溃疡穿孔7例,腹部外伤致空回肠穿孔4例,肠结核穿孔、异物（硬鱼骨）致乙状结肠穿孔、粪块性乙状结肠穿孔及子宫积脓自发穿孔各1例,15例腹部空腔脏器穿孔的主要CT征象为剑突下隐窝积气（13例）、肝下肝圆韧带间隙积气（9例）、网膜囊积气（4例）、穿孔脏器周围局限性积气（11例）、腹膜后间隙积气（1例）、腹腔积液（11例）以及肠壁增厚（3例）等。CT可直观地显示脏器穿孔破裂口、异物等,准确地判断腹腔游离气体的有无、部位和多少,并能为穿孔部位、病因、合并症的诊断提供较多有价值的信息。结论：螺旋CT可较准确地诊断腹部空腔脏器穿孔,可作为腹部X线平片的重要补充。     

Disseminated histoplasmosis: abdominal CT findings in 16 patients

Since the onset of the AIDS epidemic, disseminated Histoplasma capsulatum infection has been reported with much greater frequency in both endemic and nonendemic areas. Abdominal CT scans of 16 patients with disseminated histoplasmosis were reviewed retrospectively to identify radiologic features of this disease. The diagnosis was confirmed by autopsy (three patients), bone marrow biopsy (10 patients), lymph node biopsy (three patients), bronchoscopic biopsy (three patients), liver biopsy (two patients), and/or colonoscopic biopsy (one patient). Fourteen patients had serologic evidence of human immunodeficiency virus infection. Disseminated histoplasmosis was either the only initial manifestation of AIDS (seven patients) or was accompanied simultaneously by cytomegalovirus infection (four patients), or Kaposi sarcoma, Toxoplasma encephalitis, or cryptosporidiosis (one patient each). Abdominal CT findings included hepatomegaly (63%); splenomegaly (38%); diffuse splenic hypottenuation (19%); bilateral adrenal enlargement or hypoattenuating masses (13%); and enlarged lymph nodes with homogeneous soft-tissue density (44%), diffuse or central low density (13%), or both (19%). Histoplasmosis should be included in the differential diagnosis when abdominal CT scans show such nonspecific findings as hepatomegaly, splenomegaly, enlarged soft-tissue-density or hypoattenuating lymph nodes, or adrenal enlargement or masses in an immunodeficient patient. An uncommon but possibly specific CT finding in histoplasmosis is diffuse splenic hypoattenuation.     

Intraperitoneal tuberculous abscess: Computed tomography features

AIM: To evaluate the computed tomography (CT) features of intraperitoneal tuberculous abscess (IPTA). METHODS: Eight patients with IPTA confirmed by pathology were analyzed retrospectively. The clinical symptoms, medical images, and surgical findings were evaluated. Involvement of the intestine, peritoneum, viscera, and lymph nodes was also assessed. RESULTS: All 8 patients had a history of abdominal discomfort for 1 to 6 mo. Physical examination revealed a palpable abdominal mass in 6 patients. Three patients had no evidence of pulmonary tuberculosis (TB). All IPTAs (11 abscesses) were seen as a multiseptated, peripherally enhanced, hypodense mass with enlarged, rim-enhanced lymph nodes. The largest abscess diameter ranged from 4.5 cm to 12.2 cm. CT showed 2 types of IPTA: Lymph node fusion and encapsulation. Of the 8 patients, one had liver tuberculosis and one had splenic and ovarian tuberculosis. Two cases showed involvement of the terminal ileum and ileocecal junction. Ascites were found in 4 cases. Three patients had peritonitis and mesenteritis. Three patients showed involvement of the omentum. Three patients had histological evidence of caseating granuloma, and 5 had histological evidence of acid-fast bacilli. CONCLUSION: CT is crucial in the detection and characterization of IPTA. Certain CT findings are necessary for correct diagnosis.     

HIV感染者和AIDS患者并发肺结核的CT表现

目的 探讨HIV感染者和艾滋病患者(HIV/AIDS)并发肺结核的CT表现特征.方法回顾性分析48例HIV/AIDS并发肺结核的CT表现.结果 HIV/AIDS患者肺结核的CT表现为:继发型肺结核19例(39.6%),病变形态以斑片状阴影为主,10例可见融合成大片的实变影;血行播散型肺结核17例(35.4%),其中急性粟粒型肺结核7例,表现为大小、分布均匀的粟粒影,而亚急性血行播散型10例,表现为大小、分布不均匀的粟粒、小结节影;多种征象混合表现10例(20.8%),表现为双肺斑片状渗出病灶与弥漫分布的粟粒、小结节灶相混杂.纵隔淋巴结肿大36例(75.0%),胸腔积液13例(27.1%),心包积液10例(20.8%).结论 HIV/AIDS并发肺结核的CT特征为局灶性肺实质病变较少而弥漫性的病变较多.